<form id="change-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('商品总价')}:</label>
        <div class="col-xs-12 col-sm-8">
            <p class="form-control-static">{$row.total_price|htmlentities}</p>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('优惠金额')}:</label>
        <div class="col-xs-12 col-sm-8">
            <p class="form-control-static">{$row.discount|htmlentities}</p>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('应付金额')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-payment" class="form-control" type="text" name="row[payment]" value="{$row.payment|htmlentities}" title="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('余额支付')}:</label>
        <div class="col-xs-12 col-sm-8">
            <p class="form-control-static">{$row.balance|htmlentities}</p>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button class="btn btn-success btn-embossed disabled" type="submit">{:__('OK')}</button>
            <button class="btn btn-default btn-embossed" type="reset">{:__('Reset')}</button>
        </div>
    </div>
</form>